Understanding Breast Cancer Risk Assessment: A Guide for Patients
Know Your Risk, Take Control
Breast cancer affects one in eight US women, making risk assessment crucial for early detection and prevention. At Concierge Medicine of Cincinnati, we use validated tools like the Gail Model and Tyrer-Cuzick Model to evaluate your risk based on factors such as family history, personal health, and lifestyle.
Breast cancer is one of the most common cancers affecting women worldwide, one in eight US women will develop breast cancer in their lifetimes. Understanding individual breast cancer risk is crucial for early detection and prevention. At Concierge Medicine of Cincinnati, we want to empower women to know and understand their breast cancer risk. Our goal is to provide women with evidence-based insights into breast cancer risk assessment, helping to understand individual risk factors and the importance of proactive screening.
What is a Breast Cancer Risk Assessment?
Actress Olivia Munn recently shared with the world that a breast cancer risk assessment saved her life. Breast cancer risk assessment involves evaluating various factors that may increase a person’s likelihood of developing the disease. This assessment can help identify individuals who may benefit from enhanced screening or preventative measures. To quantify your risk, we often use validated tools like the Gail Model or the Tyrer-Cuzick Model. These tools take into account various factors including family history, personal health history, and reproductive history to estimate an individual's risk of developing breast cancer. Risk is determined over the next five years, ten years and lifetime. The Gail model calculation is five questions, but it is known to underestimate risk in certain patients because it does not take breast density into consideration and only includes first-degree family history. Conversely, the Tyrer-Cuzick model in some patients may overestimate risk but is often more accurate because it incorporates biometrics, specific reproductive factors, personal history, multi-generation family history, and breast density. Using both models provides a range of estimated risk. Both risk models are readily available and take fewer than 5 minutes to complete. In our practice, we have the ability to send a screening assessment tool prior to a visit or complete the risk-assessment models with the patient in the exam room.
The percentage of risk helps to determine the patients screening, follow up and preventative strategies.
Breast Cancer Risk Categories:
Average (<15%): Annual mammograms
Intermediate (15-19%): Annual mammograms; possible MRIs for dense breasts
High (>20%): Annual MRIs and mammograms; genetic testing discussed
Average Risk
Average risk is below 15%. Usually, annual mammograms are recommended in this case in addition to self-breast exams and clinical exams.
Intermediate Risk
Intermediate risk is between 15%-19%. If you fall under this category, annual mammograms are recommended. In addition, supplemental screening for women with high breast density breast MRIs may be recommended for patients in this category.
High Risk
High risk is greater than 20%. For patients in this group, annual screening MRIs and mammograms are recommended. Screening is recommended whether or not the patient has high breast density. For patients that cannot access MRIs, routine mammography and ultrasounds are recommended. In addition, genetic testing is often discussed with group.
Breast cancer risk factors can be categorized into modifiable and non-modifiable factors:
Non-Modifiable Risk Factors
Age: The risk increases with age, particularly after 50.
Gender: Women are at a higher risk than men.
Genetics: Family history of breast cancer, especially with BRCA1 or BRCA2 mutations.
Ethnicity: Certain ethnic groups may have a higher risk.
Personal History: Previous breast cancer or certain non-cancerous breast diseases.
Modifiable Risk Factors
Alcohol Consumption: Higher intake is associated with increased risk.
Obesity: Being overweight, especially after menopause, raises risk.
Physical Inactivity: Lack of exercise can contribute to risk.
Diet: A diet high in saturated fats and low in fruits and vegetables may increase risk.
Smoking: Tobacco use is linked to a higher risk of various cancers, including breast cancer.
Radiation Exposure: Previous radiation treatments, especially to the chest area, can elevate risk.
Key Risk Factors
Genetic Predisposition
BRCA1 and BRCA2 Genes: Mutations in these genes significantly increase the risk of breast cancer. Women with BRCA mutations have a lifetime risk of 45-65% compared to 12% for the general population.
Family History: A family history of breast cancer, particularly in first-degree relatives, can indicate a higher risk.
Age
The risk of breast cancer increases with age. Most cases are diagnosed in women over 50, with 80% of cases occurring in women aged 50 and older.
Personal Health History
A history of atypical hyperplasia or lobular carcinoma in situ can double the risk of developing breast cancer.
Prior radiation therapy to the chest area, especially during adolescence, also elevates risk.
Lifestyle Factors
Obesity, particularly after menopause, can increase breast cancer risk.
Alcohol consumption has been linked to an increased risk, with studies suggesting that even moderate drinking can elevate the risk.
Ethnicity and Geography
Certain ethnic groups have varying risks, with Caucasian women generally having higher rates than African American women, although the latter are more likely to be diagnosed at a younger age.
Preventative Strategies
If you are identified as high-risk, several strategies can be discussed with your healthcare provider:
Lifestyle Modification: Some lifestyle changes that may help reduce the risk of breast cancer include:
Maintaining a healthy weight. Both being overweight and gaining weight as an adult are linked to a higher risk of breast cancer.
Being physically active. The American Cancer Society recommends at least 150 to 300 minutes of moderate-intensity activity or 75 to 150 minutes of vigorous-intensity activity each week.
Limiting alcohol- The risk of breast cancer increases with the amount of alcohol consumed. Women who drink one alcoholic drink a day have a small increased risk, while women who drink two to three drinks a day have about a 20% higher risk.
Eating a healthy diet: A diet rich in fruits and vegetables may help prevent breast cancer.
Not smoking: Smoking during adolescence or early adulthood increases the risk of breast cancer later in life.
Enhanced Screening: This may include more frequent mammograms, MRI screenings, or ultrasound exams.
Risk-Reducing Medications: Hormonal therapies (like tamoxifen) may reduce risk for women at high risk.
Preventative Surgery: For those with significant genetic risk, options such as prophylactic mastectomy may be considered.
